Omalizumab for treatment of refractory severe atopic dermatitis. A pediatric perspective

Abstract

Omalizumab is a monoclonal antibody, targeting Fc receptor of IgE, approved for the treatment of allergic asthma and chronic spontaneous urticaria. Its utility in atopic dermatitis appears controversial from data in literature since the molecule is well tolerated but it seems less effective than other medications used in adult patients (eg, Dupilumab). At present, the use of Dupilumab is not approved in pediatric patients therefore there are no second level treatments available in this age group. Here we report two clinical cases of patients (15 and 16 years old) suffering from both atopic dermatitis and asthma, treated with Omalizumab. Our experience suggests that atopic eczema of young patients with allergic comorbidities can benefit from asthma treatment with Omalizumab observing improvement on both conditions.

Pediatric usage of Omalizumab: A promising one

“…In order to evaluate perinatal outcomes with omalizumab exposure during pregnancy, a prospective observational study compared 250 women with asthma exposed to omalizumab during pregnancy and 1153 disease-matched cohorts. 77 In the omalizumab-treated group, prevalences of major congenital anomalies, premature birth, small for gestational age were identified as 8.1%, 15.0%, 9.7%, respectively, comparable to the values (8.9%, 11.3%, 15.8%) seen in the matched group. Notably, there also was no increased risk of thrombocytopenia in the newborn.…”

“…Considering the high costs of omalizumab, dupilumab seems a better choice for controlling AD in terms of efficacy and costs. 77 In the future, the beneficial management for children with severe AD needs to be carefully evaluated with both the efficacy and costs in mind. With such criteria in mind, the role of omalizumab can not be ignored.…”

Tailored treatments in inborn errors of immunity associated with atopy (IEIs-A) with skin involvement

“…Its use in severe pediatric AD has been tested in a randomized clinical trial concluding that omalizumab is a treatment option for difficult-to-manage severe eczema in children with atopy (163). Omalizumab application in IEIs-A is limited to case reports or single clinical experience in particular in HIES with concomitant respiratory manifestations, but this application is still debated (63,(163)(164)(165)(166).…”

The Acari Hypothesis, III: Atopic Dermatitis

“…Allergen burden might be eliminated by avoiding environmental triggers that prompt microbial expression of relevant allergens (e.g., discontinue use of alkaline soaps) and/or reducing the number of allergen-producing microbes (e.g., treatment with an antibiotic or an antifungal agent). Symptom-inducing immune cascades might be interrupted using: (1) omalizumab, a monoclonal antibody that inhibits the binding of IgE to FcεRI [ 97 , 98 ], (2) tralokinumab and lebrikizumab, monoclonal antibodies that target IL-13 and its signaling [ 99 , 100 ], (3) nemolizumab, a monoclonal antibody that binds the IL-31 receptor and blocks IL-31 signaling [ 101 ], and/or (4) dupilumab, an antibody that antagonizes IL-4 at its receptor [ 102 ].…”